senator brandon beach & wayne oliver's 2013 slc presentation
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PATIENTS’ COMPENSATION SYSTEMA PROPOSAL THAT WORKS FOR PHYSICIANS AND THEIR
PATIENTS
Senator Brandon BeachDistrict 21, North Atlanta
Wayne W. OliverExecutive Director, Patients for Fair Compensation
November 1, 2013
Presentation to:AAFP State Legislative Conference
2655 Northwinds Parkway • Alpharetta, GA 30009 • 877 248 1689 • www.patientsforfaircompensation.org © Copyright 2013
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ADDRESSING A SIGNIFICANT PROBLEM
SB141 represents a bold, new, innovative approach to healthcare …
• Thousands of hours of engagement by national and international thought leaders
• Investment into clinical research, original thought leadership, data and analytics, actuarial reports, and peer-review studies
• Gaining nationwide attention as policy makers look for an answer to out-of-control healthcare costs
• PCS solution saves lives, advances patient safety, decreases the cost of healthcare, saves taxpayers, physicians and families money and fairly and appropriate compensates legitimately injured patients
2655 Northwinds Parkway • Alpharetta, GA 30009 • 877 248 1689 • www.patientsforfaircompensation.org © Copyright 2013
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THOUGHTFUL APPROACH
SB141 represents a bold, new, innovative approach to healthcare …
• Based on scientific research, data analysis, medical experts and actuarial studies
• Working with specialty and professional societies to create the best bill
• Will work with state and national societies to replicate and pass on lessons learned …
2655 Northwinds Parkway • Alpharetta, GA 30009 • 877 248 1689 • www.patientsforfaircompensation.org © Copyright 2013
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WE’RE SOUTHERNS …
We like our college football …
2655 Northwinds Parkway • Alpharetta, GA 30009 • 877 248 1689 • www.patientsforfaircompensation.org © Copyright 2013
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2655 Northwinds Parkway • Alpharetta, GA 30009 • 877 248 1689 • www.patientsforfaircompensation.org © Copyright 2013
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CURRENT TORT SYSTEM BROKEN
Promotes Defensive Medicine• GALLUP - 26% of overall healthcare costs
• Cost up to $650 Billion to US citizens• $14 billion annually to Citizens of Georgia
Prevents Access to Justice• Less than 20% of injured patients receive compensation
• Less than 1% receive Jury Award
Hurdle for Patient Safety• Unable to significantly improve under a “Blame & Shame” system…
2655 Northwinds Parkway • Alpharetta, GA 30009 • 877 248 1689 • www.patientsforfaircompensation.org © Copyright 2013
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Traditional tort reform only
reduces the cost of litigation
Patients’ Compensation System
COST OFDEFENSIVE MEDICINE
$650 Billionper year
$31 Billion **
COST OFLITIGATION
per year
Physicians in states with traditional tort reform practice same amount of defensive medicine as other states…
Source: “A Costly Defense” published by Jackson Healthcare September 21, 2011
REDUCES BOTH LITIGATION COSTS AND COST OF DEFENSIVE MEDICINE
02/25/13
** Source: BioScience Valuations report July 19, 2012
2655 Northwinds Parkway • Alpharetta, GA 30009 • 877 248 1689 • www.patientsforfaircompensation.org © Copyright 2013
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PHYSICIANS PRACTICING DEFENSIVE MEDICINE (%)
U.S. physicians are only ones personally financially liable for malpractice; and the only ones practicing defensive medicine.
Source: Pacific Research Survey June 24, 2011
U.S. Canada U.K. Sweden New Zealand0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
82%
0% 0% 0% 0%
2655 Northwinds Parkway • Alpharetta, GA 30009 • 877 248 1689 • www.patientsforfaircompensation.org © Copyright 2013
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Avoid personal financial exposure from “jackpot justice” awards from non-peers
Physicians abhor defending against lawsuits
WHY DO PHYSICIANS PRACTICE DEFENSIVE MEDICINE?
Source: “A Costly Defense” published by Jackson Healthcare September 21, 2011
2655 Northwinds Parkway • Alpharetta, GA 30009 • 877 248 1689 • www.patientsforfaircompensation.org © Copyright 2013
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82% of Georgia physicians practice defensive medicine
74% of Georgia physicians believe that defensive medicine negatively impacts patient care
95% of Georgia physicians support PCS Proposal
96% Georgia physicians agree that a PCS solution would reduce healthcare costs
WHAT HAVE GEORGIA PHYSICIANS TOLD US?
Source: “The Practice of Defensive Medicine” Oppenheim ResearchJanuary 12, 2012
2655 Northwinds Parkway • Alpharetta, GA 30009 • 877 248 1689 • www.patientsforfaircompensation.org © Copyright 2013
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DEFENSIVE MEDICINE IS REAL
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DEFENSIVE MEDICINE IS COSTLY
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DEFENSIVE MEDICINE IS PERVASIVE
2655 Northwinds Parkway • Alpharetta, GA 30009 • 877 248 1689 • www.patientsforfaircompensation.org © Copyright 2013
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DEFENSIVE MEDICINE HURTS EVERYONE
2655 Northwinds Parkway • Alpharetta, GA 30009 • 877 248 1689 • www.patientsforfaircompensation.org © Copyright 2013
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DEFENSIVE MEDICINE IS REAL
2655 Northwinds Parkway • Alpharetta, GA 30009 • 877 248 1689 • www.patientsforfaircompensation.org © Copyright 2013
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BUSINESS LEADERS ENGAGED
Atlanta Business Chronicle, 10/21/2013
2655 Northwinds Parkway • Alpharetta, GA 30009 • 877 248 1689 • www.patientsforfaircompensation.org © Copyright 2013
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Unnecessary tests & procedures
“High risk” patients denied care
• Sometimes referred to as reverse defensive medicine
Physicians cannot afford to admit mistakes
Increased overall cost of healthcare
• Both health plan and out-of-pocket expenses …
WHY DEFENSIVE MEDICINE HARMS PATIENTS?
2655 Northwinds Parkway • Alpharetta, GA 30009 • 877 248 1689 • www.patientsforfaircompensation.org © Copyright 2013
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›Drives wedge between patient / physician
›Denies access to justice
› <5% of filed cases go to jury
› Patients receive <50% of awards on legal & administrative costs
› 5 – 7 year process
› Stress of litigation…
PATIENTS LOSE IN CURRENT LITIGATION SYSTEM
Source: PIAA, 2011 ReportTowers Watson Study, 2011
2655 Northwinds Parkway • Alpharetta, GA 30009 • 877 248 1689 • www.patientsforfaircompensation.org © Copyright 2013
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CURRENT SYSTEM IN CRISIS :: ACCESS TO JUSTICE
Summary of Findings: Attorneys require $500,000 of economic
damages to take case Denies any “Access” to anyone that is on
Medicaid, Medicare, Out of Job, elderly, poor, young people
80% of all legitimate medical injuries fall UNDER $500,000
Source: JUSTICE IN CRISIS: Victim Access to American Medical Liability System, 2013
Professor Joanna Shepherd Bailey, Ph.D.Emory University School of Law
2655 Northwinds Parkway • Alpharetta, GA 30009 • 877 248 1689 • www.patientsforfaircompensation.org © Copyright 2013
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THE SOLUTION
Replace Tort System with an
Administrative Compensation System:
Patients’ Compensation System
2655 Northwinds Parkway • Alpharetta, GA 30009 • 877 248 1689 • www.patientsforfaircompensation.org © Copyright 2013
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PATIENTS’ COMPENSATION SYSTEMHOW DOES IT WORK?
PCS
Patient Advocate
Medical Review Department
Compensation Department
Administrative Law Judge
Quality Improvement
Department
IndependentMedicalReview Panel
1
2
3
4
5
6
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PATIENTS’ COMPENSATION SYSTEMPATIENT ADVOCATE
1. Patient Advocate
› Helps patient navigate through the system…
1
2655 Northwinds Parkway • Alpharetta, GA 30009 • 877 248 1689 • www.patientsforfaircompensation.org © Copyright 2013
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PATIENTS’ COMPENSATION SYSTEMMEDICAL REVIEW DEPARTMENT
› Headed by CMO – Physician
› Gathers all pertinent medical records
› Interviews all relevant parties
› Makes prima facie determination of medical injury
› Appoints expert panel…
2. Medical Review Department2
2655 Northwinds Parkway • Alpharetta, GA 30009 • 877 248 1689 • www.patientsforfaircompensation.org © Copyright 2013
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PATIENTS’ COMPENSATION SYSTEMINDEPENDENT MEDICAL REVIEW PANEL
› Pre-approved physicians and other medical experts
› 3 physicians – if only a physician is involved
› 3 physicians plus 2 other experts if system is involved
› All identifiers of patient and providers are redacted
› RESULT: Rules claim as a “Medical Injury” – “Yes” vs. “No”
3. Independent Medical Review Panel
3
2655 Northwinds Parkway • Alpharetta, GA 30009 • 877 248 1689 • www.patientsforfaircompensation.org © Copyright 2013
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PATIENTS’ COMPENSATION SYSTEMCOMPENSATION DEPARTMENT
› Total compensation may not exceed total malpractice costs for 2013
› Creates compensation schedule for each type of injury & severity
› Awards compensation if panel says medical injury has occurred…
4. Compensation Department
4
2655 Northwinds Parkway • Alpharetta, GA 30009 • 877 248 1689 • www.patientsforfaircompensation.org © Copyright 2013
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PATIENTS’ COMPENSATION SYSTEMADMINISTRATIVE LAW JUDGE
› Ensures process is applied in accordance to the law
› Limited appeal of process only…
5. Administrative Law Judge
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2655 Northwinds Parkway • Alpharetta, GA 30009 • 877 248 1689 • www.patientsforfaircompensation.org © Copyright 2013
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PATIENTS’ COMPENSATION SYSTEMQUALITY IMPROVEMENT DEPARTMENT
› Records all claims data confidentially
› Shares lessons learned with providers…
6. Quality Improvement Department
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2655 Northwinds Parkway • Alpharetta, GA 30009 • 877 248 1689 • www.patientsforfaircompensation.org © Copyright 2013
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Funded through money in system today
SOURCE OF FUNDS
2655 Northwinds Parkway • Alpharetta, GA 30009 • 877 248 1689 • www.patientsforfaircompensation.org © Copyright 2013
2655 Northwinds Parkway • Alpharetta, GA 30009 • 877 248 1689 • www.patientsforfaircompensation.org © Copyright 2013
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MORE EFFICIENT USE OF EXISTING FUNDS
3-5 years
Patient Compensation System
Current System20%
Injured Patients17.5%
Malpractice Costs
180 days 80%Malpractice
Costs
100%Injured
Patients
Source: PIAA, 2011 Report Towers Watson Study,
2011
2655 Northwinds Parkway • Alpharetta, GA 30009 • 877 248 1689 • www.patientsforfaircompensation.org © Copyright 2013
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All complaints are reviewed
Faster payment of claims – months vs. years
Reduces exposure to unnecessary tests
Guaranteed funds for avoidable medical injury
Increased patient safety
Increases Access to Justice
Injured patients are fairly compensated …
PATIENT BENEFITS
2655 Northwinds Parkway • Alpharetta, GA 30009 • 877 248 1689 • www.patientsforfaircompensation.org © Copyright 2013
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Physicians will never be sued again … Ever
No personal financial risk
Does NOT assign blame
Safe to admit mistakes
Medical malpractice premiums will decrease …
PHYSICIAN BENEFITS
2655 Northwinds Parkway • Alpharetta, GA 30009 • 877 248 1689 • www.patientsforfaircompensation.org © Copyright 2013
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Those who profit from the current system where
doctors, healthcare professionals and hospitals are
sued …
• Trial Attorneys
• Medical Malpractice Insurance Companies
WHO IS THE OPPOSITION?
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IMPACT ON MALPRACTICE COST
Categories (Cents per Dollar)
Collected Premium
Paid to Patients
Paid to Defense Attorneys
Administration Costs
Insurance Company Profit
Patient Claims
Patient Awards
Average GA Medical
Malpractice Carrier –
Current Tort Liability
1.00
0.23
0.30
0.17
0.30
2880
864
Patient Compensation
System Alternative
0.92
0.51
0.09
0.17
0.15
4796
1918
Percentage Change
-8.1%
119.8%
-68.9%
0.0%
-50.0%
66%
122%
2655 Northwinds Parkway • Alpharetta, GA 30009 • 877 248 1689 • www.patientsforfaircompensation.org © Copyright 2013
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Awards may not exceed the fiscal year 2013 aggregate costs of medical malpractice as determined by an independent actuary
Significantly decreases defensive medicine saving billions annually for Georgia families
Medical malpractice rates decrease under predictable PCS model
Georgia taxpayers reap savings which is currently being wasted on defensive medicine and med-mal defensive attorneys
NO INCREASED COSTS
2655 Northwinds Parkway • Alpharetta, GA 30009 • 877 248 1689 • www.patientsforfaircompensation.org © Copyright 2013
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The bill specifically limits the power of the medical review panel to determining avoidable harm.
No Negligence / No Lawsuit
No blame / No increased reporting
Bill specifically prohibits reporting
Shall provide Medical Board with information upon request
Public Safety Issue: May notify Medical Board of“risk of harm to the public”
NO INCREASED REPORTING
2655 Northwinds Parkway • Alpharetta, GA 30009 • 877 248 1689 • www.patientsforfaircompensation.org © Copyright 2013
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Two Actuarial Studies :: AON and BioScience Valuation
Peer review by David Frisvold (Assistant Professor, Department of Economics, Emory University) determined the following
Significant decrease in medical malpractice insurance rates & healthcare expenses
Savings to State of Georgia
› $3.1 Billion Medicaid
› $3.8 Billion State Employee Healthcare Costs
$6.9 Billion Total Savings in First 10 years
IMPACT ON GEORGIA
2655 Northwinds Parkway • Alpharetta, GA 30009 • 877 248 1689 • www.patientsforfaircompensation.org © Copyright 2013
2655 Northwinds Parkway • Alpharetta, GA 30009 • 877 248 1689 • www.patientsforfaircompensation.org © Copyright 2013
37
PCS is a Solution to Completely Replace the Current Tort System
• No more medical malpractice lawsuits
• Strong legal precedent
• Slashes defensive medicine costs
• Eliminates bad press
• Increases access to justice
• Enhances patient safety
• More efficient use of existing funds
• More patients receive more compensation
• No Cost to Georgia Taxpayers …
SUMMARY…
QUESTIONS?
Contact Information:
Wayne W. OliverExecutive Director, Patients for Fair
Compensation
E-mail: WOliver@PatientsForFairCompensation.org
Tel: 678-690-7970
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